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General NPI Number Information
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NPI Number | 1215924402
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Entity Type | Individual
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Provider Name | KENNETH TELLERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 711 W 40TH ST STE 438
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City | BALTIMORE
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State | MD
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Zip | 21211-2199
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Country | US
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Telephone | 410-243-8632
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Fax | 410-243-0470
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Provider Business Mailing Address
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Address Line | 2416 KEN OAK RD
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City | BALTIMORE
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State | MD
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Zip | 21209-4310
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Country | US
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Telephone | 410-664-6632
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Fax | 410-243-0470
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0025147
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License Number State | MD
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